Antenatal Women and their Prevalence of HIV Testing

Introduction

The Human Immunodeficiency Virus (HIV) is a virus that only infects human beings by

weakening the immune system, destroying important cells that fight disease and infection. It can

only reproduce itself by taking over a cell in the body of its host.

Unlike influenza or the common cold, the human immune system can't seem to get rid of

HIV. That means that once you have HIV, you have it for life. There is no cure for HIV. HIV can

hide for long periods of time in the body and that it attacks the T cells of your immune system,

which are necessary to fight infections and disease. HIV invades the T cells, uses them to make

more copies of itself, and then destroys them. Eventually, the loss and destruction of so many T

cells causes the body to lack the necessary resources to protect it. This causes Acquired

Immunodeficiency Syndrome (AIDS), the final stage of HIV infection. According to the Centers

for Disease Control and Prevention (2014), HIV can be transmitted through certain fluids—

blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk—from an HIV-

infected person. These fluids must come in contact with a mucous membrane or damaged tissue

or be directly injected into the bloodstream (from a needle or syringe) for transmission to

possibly occur. Hence, HIV can be passed from mother to child during child birth.

This is worrisome for the Jamaican population. Even more so, since, in Jamaica, it is

estimated that 34,000 persons are living with HIV and as many as 50% are unaware of their

status (Ministry of Health, 2012). Of this number, the study showed, in 2012, for every one

thousand pregnant women attending public antenatal clinics, at least 9 were HIV infected. While

that in itself is a low statistic, it must be recognized that this number is only among women who

have volunteered to get tested before childbirth and it does not reflect the number of women
seeking antenatal care in private hospitals. Testing is voluntary, but there are still pregnant

women who do not take advantage of the opportunity and get tested.

Therefore, there needs to be an investigation into the factors that deter antenatal women

from getting tested for HIV, especially if the test has been offered to them. This is a big issue as

HIV transmission from mother to child could have been avoided with one test. Between 1989 and

1996 the HIV prevalence among antenatal women increased from 0.14% to 1.96%. It must be noted

however that the prevalence has declined over the last 15 years, with the 2011 and 2012 rates

remaining at 1% and below. However, as it is, one thousand five hundred and fifty one (1,551)

persons died from HIV in 2012 in Jamaica alone, Ministry of Health, 2012. A reduction in the

prevalence of HIV transmission from mother to child would equate to a better quality of life for

Jamaicans.

Literature Review

There have been studies investigating the attitudes of women seeking antenatal care, and

whether or not they get tested for HIV. A lot of studies highlight the trends of HIV in general.

These are usually done in first world countries such as the United Kingdom, The United States of

America, Canada and Sweden. The studies regarding the attitudes of antenatal women towards

getting tested for HIV are mostly from African states. While the Ministry of Health has a

National HIV/STI Program Jamaica which provides an annual HIV/AIDS Epidemic Update, the

studies are not specific to antenatal women and their prevalence to get tested for HIV. In an

ideal world, HIV testing would be done by all, especially expectant mothers; however, there are

various reasons why these women fail to make this crucial decision.

While it ideal to have expectant, antenatal mothers get tested for HIV, there are negative

schemas attached to a positive HIV status, leaving them in fear of finding out their status. De

Cock & Johnson (1998) state, “Negative consequences that may result from people discovering
their positive HIV status include, psychological disturbance, rejection, stigmatization, and social,

as well as financial discrimination”. They also highlight that HIV infected women in some

settings are at increased risk of domestic violence and discrimination; hence they struggle in their

efforts to normalize HIV as a part of their lives.

Various studies have been carried out which highlight the relationship between the

attitudes of women seeking antenatal care and HIV. As such various factors affecting why

pregnant women do not get tested for HIV have been determined.

Age. Age plays a factor in whether or not expectant mothers will get tested for HIV. The

findings from a Ugandan study in 1998 by Pettifor, Rees, Kleinschmidt, Steffenson, MacPhail,

Hlongwa-Madikizela, Vermaak & Padian (2004) show that younger expectant mothers are more

likely to contract HIV. One third (1/3) of the Ugandan girls between ages fifteen and nineteen

(15-19) reported they were pregnant. Fifteen percent (15%) of them had HIV. They were the

highest recorded age cohort with pregnant women having HIV. In Brazil, a study took the

examination of age of expectant mothers and HIV prevalence one step further by examining the

prevalence of HIV testing among expectant mothers. It was found that younger girls, especially

those who had not finished receiving a primary or secondary education, had higher incidence of

failure to get tested for HIV. Authors of this study, Szwarcwald, Barbosa Júnior, Souza-Júnior,

Lemos, Frias, Luhm, Holcman, & Esteves (2008), found that pregnant women nineteen (19)

years and younger had a statistically higher failure rate to get tested for HIV compared to the

other age groups. Furthermore, pregnant women seeking antenatal care were found to be more

likely to get tested for HIV the older they became. This was seen as women thirty five (35) and

older had the lowest incidence of failure to get tested for HIV.
 Relationship Status. Research has shown that the relationship status of women seeking

antenatal care affects whether or not they get tested for HIV. A Kenyan study by Turan, Bukusi,

Onono, Holzemer, Miller, & Cohen, C. R. (2011) showed pregnant women were less likely to

get tested for HIV because, in the event of being HIV positive, the women anticipated break ups

and violence from their male partners. Furthermore, pregnant women are usually the first in the

family to get tested for HIV, and if the woman is HIV positive, she is blamed for diseasing and

bringing discrimination on the family. Hence, pregnant women refuse testing, sometime

foregoing antenatal care all together. Turan, Bukusi, Onono, Holzemer, Miller, & Cohen (2011)

also found that a significant number expectant mothers who were married did not get tested is

because they were already aware of their husbands’ HIV positive status. Disclosure of this also

leads to discrimination and violence towards the woman. Pettifor et al (2004) also found that

pregnant women with more than one sexual partner had a significantly higher risk of being

infected with HIV. It can be inferred that pregnant women who are not in a stable relationship

are at risk of contracting HIV. Corbett, Dauya, Matambo, Cheung, Makamure, Bassett, & Hayes

(2006) found women in general who were married were less likely to get tested for HIV.

Employment Status. The employment status of women seeking antenatal care also

influences whether or not mothers seeking antenatal care will get tested for HIV. In a Tanzanian

study by de Paoli, Manongi & Klepp (2004), there a statistically significant relationship between

employment of expectant mothers and their attitude towards HIV. Majority of the women who

were unemployed and seeking antenatal care claimed they were economically dependent on their

husbands. Should they find out they were HIV positive, the women feared abuse and violence

from their spouses. Corbett et al (2006) found that women seeking antenatal care who were in

the work place were most get tested for HIV in a convenient place where they were less likely to
be seen by persons who could recognize them. They also found out that the cost of HIV testing

was also important to women seeking antenatal care, who were also employed.

Other Reasons. There are other reasons however that could explain why women seeking

antenatal care do not get tested for HIV. De Cock & Johnson (1998) propose another reason why

pregnant women do not seek voluntary HIV testing. They claim a major factor influencing rates

of testing is the attitude of attending midwives and obstetricians. Reticence to advocate testing is

often related to concerns about involuntary testing, stigmatization, and discrimination against

women seen to be at high risk, since the highest prevalence of HIV infection is in women of

African origin. Some women simply were not offered the test. Hence, they did not see it as an

option and did not get tested.

Research Topic

This study is attempting to explore the possible relationship between the attitudes of

women seeking antenatal care and HIV testing, using age, relationship status and employment

status as variables. The research question is then, “Whether or not women seeking antenatal care,

who have been offered to receive an HIV test will agree to get tested for HIV, is dependent on

the woman’s age, relationship status and employment status.” This will be broken down into

three (3) hypotheses. The first hypothesis states, “As the age of women seeking antenatal care

increases, the likelihood that she will get tested for HIV, provided the test has been offered to her

also increases”. The second hypothesis proposes, “There is a relationship between a woman

seeking antenatal care’s relationship status and the likelihood that she will get tested for HIV,

provided the test has been offered to her. The final hypothesis purports that, “Women seeking

antenatal care who are married are less likely to get tested for HIV, compared to unmarried

women seeking antenatal care, provided the test has been offered to her.
References

Centers for Disease Control and Prevention. (2014). HIV Basics. Retrieved from

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Hayes, R. J. (2006). Uptake of workplace HIV counselling and testing: a cluster-

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de Cock, K. M., & Johnson, A. M. (1998). From exceptionalism to normalization: a reappraisal

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de Paoli, M. M., Manongi, R., & Klepp, K. I. (2004). Factors influencing acceptability of

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